The Anterolateral Thigh Flap for Lower Extremity Reconstruction

ABSTRACT

The anterolateral thigh flap can be considered to be one of the workhorses of perforator flaps. Its ease of dissection together with the long and reliable pedicle make it extremely suitable as a free-skin flap. The versatility of the flap allows for multiple skin islands on one pedicle, “chimeric” type of flaps, and proximally and distally based local pedicled flaps as well. However, especially in the Caucasian patient, the flap can be rather thick, and the donor-site morbidity is not always accepted, which limits somewhat its popularity in lower extremity reconstruction, though in selected cases it proves to be an extremely useful adjunct to our reconstructive possibilities of the lower leg.

KEYWORDS

Anterolateral thigh flap - lateral circumflex femoral artery-vastus lateralis perforator flap - lower extremity

REFERENCES

• 1 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 149-159
• 2 Mardini S, Lin C H, Wei F C. In: Blondeel PN, Morris SF, Hallock GG, et al Perforator Flaps: Anatomy, Technique & Clinical Applications. St. Louis, MO; Quality Medical Publishing 2006: 617-633
• 3 Wei F C, Jain V, Celik N et al.. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.  Plast Reconstr Surg. 2002;  109 2219-2226 discussion 2227-2230
• 4 Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction.  J Reconstr Microsurg. 2003;  19 225-233
• 5 Chen H C, Tang Y B. Anterolateral thigh flap: an ideal soft-tissue flap.  Clin Plast Surg. 2003;  30 383-401
• 6 Ozkan O, Coskunfirat O K, Ozgentas H E. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap.  J Reconstr Microsurg. 2004;  20 377-383
• 7 Kaplan J L, Allen R J, Guerra A et al.. Anterolateral thigh flap for breast reconstruction: review of the literature & case reports.  J Reconstr Microsurg. 2003;  19 63-68
• 8 Yu P, Sanger J R, Matloub H S et al.. Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction.  Plast Reconstr Surg. 2002;  109 610-616
• 9 Wang H T, Fletcher J W, Erdman D et al.. Use of the anterolateral thigh free flap for upper extremity reconstruction.  J Hand Surg [Am]. 2005;  30 859-864
• 10 Kuo Y R, Jeng S F, Kuo M H et al.. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site.  Plast Reconstr Surg. 2001;  107 1766-1771
• 11 Ozkan O, Coskunfirat O K, Ozgentas H E. The use of the free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities.  Ann Plast Surg. 2004;  53 455-461
• 12 Pan S C, Yu J C, Shieh S J et al.. Distally-based anterolateral thigh flap: an anatomic and clinical study.  Plast Reconstr Surg. 2004;  114 1768-1775
• 13 Gravvanis A I, Inconomou T G, Panayotos P N et al.. Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: conservative or modern approach to exposed knee joint?.  Plast Reconstr Surg. 2005;  116 932-934
• 14 Yildirim S, Avci G, Akan M et al.. Anterolateral thigh flap in the treatment of postburn flexion contractures of the knee.  Plast Reconstr Surg. 2003;  111 1630-1637
• 15 Hallock G G. The proximal pedicled anterolateral thigh flap for lower limb coverage.  Ann Plast Surg. 2005;  55 466-469
• 16 Iida H, Kishimoto S, Umeda T et al.. Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry.  Br J Plast Surg. 2003;  56 21-25
• 17 Tsukino A, Kurachi K, Inamiya T et al.. Preoperative color Doppler assessment in planning of anterolateral thigh flaps.  Plast Reconstr Surg. 2004;  113 241-246
• 18 Wei F C, Mardini S. Free-style free flaps.  Plast Reconstr Surg. 2004;  114 910-916
• 19 Hage J J, Woerdeman L H. Lower limb necrosis after use of the anterolateral thigh free flap: is preoperative angiography indicated?.  Ann Plast Surg. 2004;  52 315-318
• 20 Koshima I, Yamamoto H, Hosoda M et al.. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle.  Plast Reconstr Surg. 1993;  92 411-420
• 21 Tsai F C, Yang J Y, Mardini S et al.. Free split-cutaneous perforator flaps procured using a three-dimensional harvest technique for the reconstruction of postburn contracture defects.  Plast Reconstr Surg. 2004;  113 185-193
• 22 Hallock G G. The preexpanded anterolateral thigh flap.  Ann Plast Surg. 2004;  53 170-173
• 23 Yamada N, Kakibuchi M, Kitayoshi H et al.. A new way of elevating the anterolateral thigh flap.  Plast Reconstr Surg. 2001;  108 1677-1682
• 24 Ross G L, Dunn R, Kirkpatrick G et al.. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects.  Br J Plast Surg. 2003;  56 409-413
• 25 Kimura N, Satoh K, Hasumi T et al.. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients.  Plast Reconstr Surg. 2001;  108 1197-1208
• 26 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap.  Plast Reconstr Surg. 1996;  97 985-992
• 27 Kawai K, Imanishi N, Nakajima H et al.. Vascular anatomy of the anterolateral thigh flap.  Plast Reconstr Surg. 2004;  114 1108-1111
• 28 Alkureishi L WT, Shaw-Dunn J, Ross G L. Effects of thinning the anterolateral thigh flap on the blood supply to the skin.  Br J Plast Surg. 2003;  56 401-408
• 29 Koshima I, Kawada S, Etoh H et al.. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.  Plast Reconstr Surg. 1995;  95 252-260
• 30 Koshima I, Fujitsu M, Ushio S et al.. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects.  Plast Reconstr Surg. 2005;  115 155-162